Healthcare Provider Details

I. General information

NPI: 1659440451
Provider Name (Legal Business Name): DALE A STOCKTON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 S LOCUST ST
PANA IL
62557
US

IV. Provider business mailing address

128 S LOCUST ST
PANA IL
62557
US

V. Phone/Fax

Practice location:
  • Phone: 217-562-3330
  • Fax:
Mailing address:
  • Phone: 217-562-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019031540
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: